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Intensive Care Needs and Short-Term Outcome of Multisystem Inflammatory Syndrome in Children (MIS-C): Experience from
Suresh Kumar Angurana1, Puspraj Awasthi1, Ajay Thakur1
1Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
Insights
Multisystem inflammatory syndrome in children (MIS-C) often presents with fever, mucocutaneous, and gastrointestinal symptoms, frequently leading to shock and requiring intensive care. Early diagnosis and treatment, including immunomodulation, improve short-term outcomes for pediatric patients with MIS-C.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Pediatric rheumatology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition linked to COVID-19.
- Understanding MIS-C's intensive care needs and outcomes is crucial for effective management.
Purpose of the Study:
- To describe the intensive care requirements and outcomes of children diagnosed with MIS-C.
- To identify key clinical features, diagnostic findings, and treatment strategies for severe MIS-C cases.
Main Methods:
- Retrospective study of 40 children with MIS-C admitted to a tertiary care hospital in North India.
- Data collected included clinical presentation, laboratory results, intensive care interventions, treatments, and short-term outcomes.
- Diagnostic methods included serology and PCR for SARS-CoV-2, alongside echocardiography.
Main Results:
- Fever, mucocutaneous, abdominal, and respiratory symptoms were common; 80% of children experienced shock.
- Most patients required Pediatric Intensive Care Unit (PICU) admission with significant need for respiratory and vasoactive support.
- Cardiovascular involvement, including myocardial dysfunction (72.5%) and coronary artery dilatation (22.5%), was prevalent.
- Immunomodulatory therapy with intravenous immunoglobulin and steroids, along with aspirin, was widely used.
Conclusions:
- Cardiovascular compromise and shock characterize severe MIS-C.
- Early recognition is vital due to overlapping symptoms with other pediatric conditions.
- Prompt organ support and immunomodulation lead to favorable short-term outcomes in pediatric MIS-C patients.
Objectives:
To describe the intensive care needs and outcome of multisystem inflammatory syndrome in children (MIS-C).
Methodology:
This retrospective study was conducted in the pediatric emergency, pediatric intensive care unit (PICUs) and the coronavirus disease 2019 (COVID 19) hospital of a tertiary teaching and referral hospital in North India over a period of 5 months (September 2020 to January 2021). Clinical details, laboratory investigations, intensive care needs, treatment and short-term outcome were recorded.
Results:
Forty children with median interquartile range age of 7 (5-10) years were enrolled. The common clinical features were fever (97.5%), mucocutaneous involvement (80%), abdominal (72.5%) and respiratory (50%) symptoms. Shock was noted in 80% children. Most cases (85%) required PICU admission where they received nasal prong oxygen (40%), non-invasive (22.5%) and invasive (22.5%) ventilation and vasoactive drug support (72.5%). The confirmation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) exposure was in the form of positive serology (66.7%), reverse transcriptase polymerase chain reaction (10%), and contact with SARS-CoV-2 positive case (12.5%). The common echocardiographic findings included myocardial dysfunction (ejection fraction <55%; 72.5%), and coronary artery dilatation or aneurysm (22.5%). The immunomodulatory treatment included intravenous immunoglobulin (2 g/kg) (100%) and steroids (methylprednisolone 10-30 mg/kg/day for 3-5 days) (85%). Aspirin was used in 80% and heparin (low molecular weight) in 7.5% cases. Two children died (5%) and median duration of PICU and hospital stay in survivors were 5 (2-8) and 7 (4-9) days, respectively. Children with shock showed higher total leucocyte count and higher rates of myocardial dysfunction.
Conclusion:
Cardiovascular involvement and shock are predominant features in severe disease. Early diagnosis can be challenging given the overlapping features with other diagnoses. A high index of suspicion is warranted in children with constellation of fever, mucocutaneous, gastrointestinal and cardiovascular involvement alongwith evidence of systemic inflammation and recent or concurrent SARS-CoV-2 infection. The short-term outcome is good with appropriate organ support therapies and immunomodulation.
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